Synchronous carcinomas of the esophagus: Influence of prognosis and staging

Synchronous carcinomas of the esophagus (SCEs), occurring at multiple locations in the esophagus or the esophagogastric junction, are uncommon. In this study, we retrospectively analyzed patients with SCEs, focusing on the types of SCEs and their influence on staging and prognosis.

Data of patients treated surgically for esophageal carcinoma between January 2009 and January 2016 were retrieved from the database in the thoracic surgery department of our hospital. The clinicopathologic features of SCEs were collected. The factors on TNM staging and prognosis of SCEs were also analyzed.

A total of 103 patients (2.8 %) with SCEs were found among 3662 consecutive patients. Based on the features of multiple carcinomas, 13 patients (0.35 %) exhibited intramural skip metastasis and 90 patients (2.46 %) displayed multiple primary carcinomas (MPCs). Patients with single esophageal cancer were propensity-matched at a ratio of 1:2 as control group. Among the patients with MPCs, tumor B was defined as the relatively early or superficial lesion. The 5-year OS of patients with MPCs with Tumor B (T1b/2) vs. matched group was 35.0 % vs. 48.45 % respectively (P = 0.013). For the N-stage of SCEs, a revised N-staging system, based on the number of involved lymph node stations better separated sub-N-stage survival curves (P = 0.002), compared with the conventional system (P = 0.019).

For the pT-stage evaluation of MPCs, the second tumor should be taken into consideration. The revised N-staging system could better reflect the lymph node metastatic characteristics and predict survival in SCEs.